A 2-year-old child presents with bow legs, craniotabes, and widening of the wrists. Investigations show low serum calcium, low phosphate, elevated alkaline phosphatase, and a 'fraying and cupping' appearance of the distal radius metaphysis on X-ray. What is the MOST likely nutritional deficiency?

• A Vitamin A deficiency
• B Vitamin D deficiency ✓
• C Vitamin C deficiency
• D Calcium deficiency alone

Explanation

This is nutritional rickets due to Vitamin D deficiency. The classic triad of clinical features includes craniotabes (softening of the occipital skull), rachitic rosary (beading at costochondral junctions), widening of wrists and ankles, and bowing of long bones. Biochemically, there is hypocalcemia, hypophosphatemia, and markedly elevated ALP. X-ray findings of fraying, cupping, and splaying of metaphyses are pathognomonic. Treatment is Vitamin D supplementation (cholecalciferol).

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.